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Phrenic nerve injury during coronary artery bypass.
MedLine Citation:
PMID:  15227189     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
After coronary artery bypass, some patients have diaphragmatic elevation, usually on the left side. To test our hypothesis that this phenomenon is due to phrenic nerve injury resulting from either 1) dissection of the proximal portion of the left internal mammary artery or 2) topical cooling of the heart with icy slush, we performed the following 2-part study. First, we reviewed our hospital records of 99 coronary artery bypass patients, 55 of whom had received left internal mammary artery grafts and 44 of whom had undergone saphenous vein grafting; the results showed no significant difference between the rates of left-sided diaphragmatic paralysis in the 2 groups (47% versus 41%, respectively). Next, we performed a prospective, randomized study in 100 consecutive patients, using a cardiac insulation pad to protect the left phrenic nerve in 58 patients and using no protective pad in 42 patients. At the time of hospital discharge, left-sided diaphragmatic elevation was seen in 6 (10.3%) of the 58 patients in whom insulation had been used and in 19 (45.2%) of the 42 patients whose phrenic nerve had been unprotected (p < 0.001). We conclude that cooling of the left phrenic nerve with icy slush in the pericardial cavity causes left-sided diaphragmatic paralysis and that the frequency of this injury can be reduced if a cardiac insulation pad is placed between the nerve and the icy slush.
Authors:
G A Guinn; A C Beall; N Lamki; J Heibig; J Thornby
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  17     ISSN:  0730-2347     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  1990  
Date Detail:
Created Date:  2004-06-30     Completed Date:  2005-05-16     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  48-50     Citation Subset:  -    
Affiliation:
The Department of Surgery, Baylor College of Medicine and Veterans' Administration Medical Center, Houston, Texas, USA.
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